Intracranial hemorrhage in acute coronary syndrome: incidence, predictors, and outcomes from APPRAISE-2, PLATO, and TRACER

Abstract

Purpose/Methods: We pooled patient-level data from cohorts with non–ST-segment elevation acute coronary syndromes (NSTE ACS) from 3 antithrombotic therapy trials to evaluate intracranial hemorrhage (ICH). Multivariable modeling identified independent predictors of ICH. Results: Of 31,416 patients included, 108 (0.3%) had an ICH. The median follow-up was 332 (184, 434) days but differed across trials. Those with ICH were older (median 69 vs 65 years), more often had history of prior transient ischemic attack (TIA)/stroke (15% vs 8%), and had higher median baseline systolic blood pressure (SBP) (137 vs 130 mmHg). Locations of ICH were intracerebral (59%), subdural (9%), subarachnoid (9%), and intraventricular (10%). Of all ICH events, 47 (43%) were associated with death, which occurred within 30 days in 40 (85%) cases. Predictors of ICH are listed, and a Kaplan-Meier curve is displayed. View this table: Independent predictors of ICH ![Figure][1] Conclusion: In these trials, ICH was uncommon. Patients with older age, higher SBP, and prior TIA/stroke were at increased risk. ICH was associated with high mortality, and the risk increased over time. Integrating biomarker and genetic data is required to perhaps better identify ACS patients at risk of ICH. [1]: pending:yes